Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China.

BACKGROUND: Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version. METHODS: A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test-retest reliability were based on structural consistency across three time points. RESULTS: The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4. CONCLUSIONS: This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.

Psychometric properties and Longitudinal Measurement Invariance of the Spanish version of the Alcohol Expectancies Questionnaire Short Form among young adult binge drinkers.

Background: Longitudinal Measurement Invariance (LMI) is critically important to evaluate changes in alcohol expectancies over time. However, past research has not explored the longitudinal properties of the Spanish Expectancy Questionnaire Short Form (EQ-SF).Objectives: To examine the reliability, sources of validity (structural, invariance across sex, and concurrent validity), and LMI of the Spanish EQ-SF among young adults who engage in binge drinking.Methods: Participants (n = 279; 48.4% female) completed the EQ-SF and, two months later, completed it again along with measures of alcohol use, drinking motives, and protective behavioral strategies (PBS). We performed confirmatory factor analysis for structural validity and measurement invariance analysis for longitudinal and sex stability.Results: The eight-factor intercorrelated model (i.e. social facilitation, fun, sexual disinhibition, tension reduction, antisocial effects, negative emotional states, negative physical effects, and cognitive impairments) provided the best fit (χ2(df) = 497.29(224), CFI = .962, RMSEA = .064, SRMR = .049). This model was invariant across sex and time. Reliability coefficients (Ordinal alpha) for each dimension were consistently strong at both time points (from .72 to .93 at T1 and .73 to .91 at T2). Positive alcohol expectancies at baseline were positively related to alcohol use and drinking motives and negatively related to PBS at follow-up, demonstrating predictive validity.Conclusion: Our results support the temporal invariance of the EQ-SF scores among Spanish young adults who engage in binge drinking. The evidence supports the suitability of this measure for accurately assessing changes in alcohol expectancies over time in interventions aimed at preventing binge drinking in young adults.

The Bergen-Yale Sexual Addiction Scale (BYSAS): Longitudinal Measurement Invariance Across a Two-Year Interval.

The Bergen-Yale Sexual Addiction Scale (BYSAS; [1]) is arguably the most popular questionnaire at present for assessing sex addiction. Employing Confirmatory Factor Analysis (CFA) and treating item scores as ordered categorical, we applied Weighted Least Square Mean and Variance Adjusted Chi-Square (WLSMV) extraction to investigate the longitudinal measurement and structural invariance of ratings on the BYSAS among 276 adults (mean = 31.86 years; SD = 9.94 years; 71% male) over a two-year period, with ratings at three yearly intervals. Overall, there was support for configural invariance, full loading, full threshold, the full unique factor invariance; and all structural (latent variances and covariances) components. Additionally, there was no difference in latent mean scores across the three-time points. The psychometric and practical implications of the findings are discussed.

Longitudinal measurement invariance and growth curve modeling of psychological resilience across the deployment cycle.

The concept of resilience is embedded within military culture and professional identity. To date, temporal changes in individuals' perceptions of their own resilience have not been systematically assessed in highstakes occupational contexts, like the military. The current study examined change in selfreported resilience over time by: (1) examining the longitudinal measurement invariance of the Brief Resilience Scale (BRS); (2) assessing the longitudinal pattern of resilience across a combat deployment cycle; and (3) examining predictors of postdeployment resilience and change in resilience scores across time. U.S. Army soldiers assigned to a combat brigade completed a survey at four time points over the course of a deployment cycle: (a) prior to deployment to Afghanistan; (b) during deployment; (c) immediately following return to home station; and (d) approximately 2-3 months thereafter. The longitudinal measurement invariance of the BRS was established. Growth curve modeling indicated that, on average, self-reported resilience decreased across the deployment cycle, but there was considerable individual variation in the rate of change. Of note, loneliness, as measured during deployment, predicted the rate of change in self-reported resilience over time. Results have implications for the longitudinal analysis of resilience and for the development of interventions with military personnel.

Strategies of Managing Repeated Measures: Using Synthetic Random Forest to Predict HIV Viral Suppression Status Among Hospitalized Persons with HIV.

The HIV/AIDS epidemic remains a major public health concern since the 1980s; untreated HIV infection has numerous consequences on quality of life. To optimize patients' health outcomes and to reduce HIV transmission, this study focused on vulnerable populations of people living with HIV (PLWH) and compared different predictive strategies for viral suppression using longitudinal or repeated measures. The four methods of predicting viral suppression are (1) including the repeated measures of each feature as predictors, (2) utilizing only the initial (baseline) value of the feature as predictor, (3) using the last observed value as the predictors and (4) using a growth curve estimated from the features to create individual-specific prediction of growth curves as features. This study suggested the individual-specific prediction of the growth curve performed the best in terms of lowest error rate on an independent set of test data.

Longitudinal measurement invariance of the international spinal cord injury quality of life basic data set (SCI-QoL-BDS) during spinal cord injury/disorder inpatient rehabilitation.

PURPOSE: This study aimed at testing the internal consistency and longitudinal measurement invariance of a brief quality of life questionnaire-the spinal cord injury quality of life basic data set (SCI-QoL-BDS)-among individuals with spinal cord injury/disorder undergoing first inpatient rehabilitation. METHODS: Longitudinal data from the Swiss spinal cord injury inception cohort study were used. Participants (n = 218) completed the SCI-QoL-BDS at one and three months post injury and at discharge. The SCI-QoL-BDS consists of three items assessing satisfaction with life as a whole, physical health, and psychological health. Internal consistency was examined at each time point and longitudinal measurement invariance was tested using longitudinal confirmatory factor analysis. RESULTS: Internal consistency coefficients ranged between .82 and .90. The confirmatory factor analysis revealed invariance of the factor structure and of all factor loadings across time. Additionally, all item intercepts except the one of satisfaction with physical health were invariant across time, suggesting partial intercept invariance of the SCI-QoL-BDS. Indeed, a response shift was observed in satisfaction with physical health. This item was evaluated more negatively in the early phase of inpatient rehabilitation, indicating the change of the evolving physical situation after the onset of a spinal cord injury. CONCLUSION: The SCI-QoL-BDS is a consistent and valid measure to assess quality of life among individuals undergoing first spinal cord injury/disorder inpatient rehabilitation. However, we recommend using latent variable frameworks instead of mean scores when examining longitudinal changes in the measure to account for potential response shift.

Factor structure and longitudinal measurement invariance of the K6 among a national representative elder sample of China.

BACKGROUND: As the number of older people is rapidly growing, prevention, screening, and treatment of mental health problems (including anxiety and depression) in this population increasingly become a heavy burden to individuals, families, and even the whole society. The Kessler-6 screening measure (K6) is an efficient and effective instrument for general mental health problems. However, few studies have examined its measurement invariance across time, which is particularly important in longitudinal studies, such as exploring developmental trajectories of non-specific psychological distress and evaluating the effects of certain interventions. METHODS: The current study investigated the factor structure and the longitudinal measurement invariance of the K6 among a national representative elder sample of China. Longitudinal data in two survey waves (the year 2010, and the year 2014) from the China Family Panel Studies were drawn for secondary data analysis. A total of 3845 participants aged 60 years old and above (52.2% male, mean age = 66.99 years, SD = 5.93 years) responded to both waves of the survey. RESULTS: A comparison of four existing models with confirmatory factor analysis supported a two-factor solution of the K6. A series of multi-group confirmatory factor analyses further indicated that the K6 held strict longitudinal measurement invariance across time. Additionally, the internal consistency indices across time and the stability coefficients over time were acceptable. CONCLUSIONS: The findings further confirmed the psychometric defensibility of the K6 when used in the old Chinese population. The longitudinal measurement invariance justified comparisons of psychological distress scores among different measurement time points.

Circulating PD-L1 levels change during bevacizumab-based treatment in recurrent glioma.

PURPOSE: In primary brain tumors, the efficacy of immune-modulating therapies is still under investigation as inflammatory responses are restricted by tight immunoregulatory mechanisms in the central nervous system. Here, we measured soluble PD-L1 (sPD-L1) in the plasma of patients with recurrent glioblastoma (GBM) and recurrent WHO grade II-III glioma treated with bevacizumab-based salvage therapy. METHODS: Thirty patients with recurrent GBM and 10 patients with recurrent WHO grade II-III glioma were treated with bevacizumab-based salvage therapy at the Medical University of Vienna. Prior to each treatment cycle, EDTA plasma was drawn and sPD-L1 was measured applying a sandwich ELISA with a lower detection limit of 0.050 ng/ml. Leukocyte counts and C-reactive protein (CRP) levels were measured according to institutional practice. RESULTS: Median number of sPD-L1 measurements was 6 per patient (range: 2-24). At baseline, no significant difference in sPD-L1 concentrations was observed between WHO grade II-III glioma and GBM. Intra-patient variability of sPD-L1 concentrations was significantly higher in WHO grade II-III glioma than in GBM (p = 0.014) and tendentially higher in IDH-mutant than in IDH-wildtype glioma (p = 0.149) In WHO grade II-III glioma, sPD-L1 levels were significantly lower after one administration of bevacizumab than at baseline (median: 0.039 ng/ml vs. 0.4855 ng/ml, p = 0.036). In contrast, no significant change could be observed in patients with GBM. CONCLUSIONS: Changes in systemic inflammation markers including sPD-L1 are observable in patients with recurrent glioma under bevacizumab-based treatment and differ between WHO grade II-III glioma and GBM.

The strength of motivation for medical school: A three-year longitudinal study.

Based on longitudinal data collected in a sample of Chinese medical students, this study tested the measurement invariance of the strength of motivation for medical school framework and examined the growth trajectories of their motivation for medical school over time. Results revealed that the strength of motivation for medical school scale demonstrated longitudinal measurement invariance. Medical students in our sample showed an overall decline over time in all three types of motivation for medical school. Most of the drop occurred during the first year of medical study. Individual variability was observed in the initial levels and the growth rates of motivation for medical school. We advised medical educators to provide sustained support to help medical students (especially for those early in medical school) improve their learning experience.

Greek Validation of the Factor Structure and Longitudinal Measurement Invariance of the Strengths and Difficulties Questionnaire-Self Report (SDQ-SR): Exploratory Structural Equation Modelling.

The study examined the factor structure and longitudinal measurement invariance over three time points (1-year apart) of the Strengths and Difficulties Questionnaire-Self Report (SDQ-SR) for ratings provided by adolescents in Greece. It used exploratory structural equation modelling (ESEM) to achieve these two goals. At time point one, a total of 968 adolescents (males = 508, and females = 460) between 12 and 17.9 years completed the SDQ-SR. In relation to factor structure, ESEM tested the fit of one- to five-factor models. The findings were interpreted as indicating most support for the ESEM model with three factors (the factors being dysregulation, peer problems, and prosocial behaviour). This model showed support for configural invariance and full metric invariance across the three time points. Except for two thresholds, all other thresholds were also invariant across the three time points. Thus, there was good support for longitudinal measurement invariance. The implications of the findings for use of the SDQ-SR are discussed.

Longitudinal measurement invariance of the Satisfaction With Life Scale in adolescence.

PURPOSE: The main purpose of this research was to examine the longitudinal measurement invariance of the Satisfaction With Life Scale (SWLS) in adolescence. METHOD: The sample was composed by 484 adolescents from Spain, 46.7% were males. All participants belonged to six academic levels from Grade 7 to Grade 12, and answered the questionnaires at two different times: at the beginning (Mage1 = 14.95, SD1 = 1.81) and at the end of the school year (Mage2 = 15.61, SD2 = 1.81). The reliability of the scale was obtained through Cronbach's alpha, Guttman lambda, and MacDonald's Omega total. The multiple group confirmatory factor analysis (MGCFA) was used to examine the fit of the unifactorial model to data and to test the measurement of longitudinal invariance of the scale across two time points (at the beginning T1, and the end T2, of the academic year), and the time points and groups (gender and age). RESULTS: The values of the single-factor SWLS structure were T1 (CFI1 = 1.000, TLI1 = .997, RMSEA1 = .080, and SRMR1 = .028), and T2 (CFI2 = .997, TLI2 = .995, RMSEA2 = .032, and SRMR2 = .034). On the other hand, values of the reliability and composite reliability when analyzing both time points together as well as separately were as follows: Cronbach's alpha = .86, Guttman's lambda = .84, McDonald's Omega total = .89. Results confirmed the longitudinal invariance of SWLS. The differences in gender and age were not significant and the small differences across time points showed that the means of the latent factor remained the same over time in both variables. CONCLUSION: The present study confirmed the single-factor structure of the SWLS in Spanish adolescents, as well as a good reliability and composite reliability. The full longitudinal measurement invariance was also found and there were negligible differences across time points considering gender and age. If these findings are further replicated, the scale could be used to compare the life satisfaction across two time points considering different age and gender groups.

A Conversation between Theory, Methods, and Data.

The 10 year anniversary of the COGITO Study provides an opportunity to revisit the ideas behind the Cattell data box. Three dimensions of the persons × variables × time data box are discussed in the context of three categories of researchers each wanting to answer their own categorically different question. The example of the well-known speed-accuracy tradeoff is used to illustrate why these are three different categories of statistical question. The 200 persons by 100 variables by 100 occasions of measurement COGITO data cube presents a challenge to integrate theories and methods across the dimensions of the data box. A conceptual model is presented for the speed-accuracy tradeoff example that could account for cross-sectional between persons effects, short-term dynamics, and long-term learning effects. Thus, two fundamental differences between the time axis and the other two axes of the data box include ordering and time scaling. In addition, nonstationarity in human systems is a pervasive problem along the time dimension of the data box. To illustrate, the difference in nonstationarity between dancing and conversation is discussed in the context of the interaction between theory, methods, and data. An information theoretic argument is presented that the theory-methods-data interaction is better understood when viewed as a conversation than as a dance. Entropy changes in the development of a theory-methods-data conversation provide one metric for evaluating scientific progress.

Developmental Change in Loneliness and Attitudes Toward Aloneness in Adolescence.

Adolescents are particularly vulnerable to experiencing feelings of loneliness. Changes in different social contexts and the inability to cope with these changes can result in different types of loneliness. According to the multidimensional view on loneliness, loneliness can be experienced in relationships with peers and parents and can be placed in a broader perspective by taking into account attitudes toward aloneness (i.e., positive and negative). However, we do not yet know how loneliness and attitudes toward aloneness develop across adolescence. These developmental trends were examined in two samples of Flemish adolescents consisting of 834 adolescents (61.9% girls, M age = 14.84; Sample 1), and 968 adolescents (58.6% girls, M age = 14.82; Sample 2), respectively. Adolescents filled out the Loneliness and Aloneness Scale for Children and Adolescents (LACA) during regular school hours on three (Sample 1) and four (Sample 2) measurement occasions with a 1-year interval. Latent growth curve modeling (LGCM) was applied. In line with theoretical notions, adolescents' parent-related loneliness and positive attitude toward aloneness were expected to increase, and adolescents' peer-related loneliness and negative attitude toward aloneness were expected to decrease. Clear evidence was found for the hypotheses regarding attitudes toward aloneness. The results regarding peer-related loneliness were inconsistent across samples and parent-related loneliness decreased, which was in contrast with theoretical expectations. In general, the two types of loneliness and attitudes toward aloneness changed in different directions during adolescence, suggesting the added value of a multidimensional view on loneliness.

Longitudinal measurement invariance of the Dutch Outcome Questionnaire-45 in a clinical sample.

PURPOSE: In the absence of measurement invariance across measurement occasions, change scores based on pretest-posttest measurements may be inaccurate representations of real change on the latent variable. In this study, we examined whether measurement invariance held in the Dutch version of Outcome Questionnaire-45 (OQ-45). METHOD: Using secondary data analysis of a sample of N = 540 Dutch outpatients, we tested the stability of the factorial structure (gamma change) and the metric and scalar invariance (beta change) across pretest and posttest measurements using a combination of factor analysis and item response theory methodology. RESULTS: Results revealed a stable factorial structure from pretest to posttest and minor violations of metric invariance for two items in the Dutch OQ-45. CONCLUSION: Even though for two items the assumption of invariance was violated, results suggest that the effects of these violations on practical change assessment using the OQ-45 were negligible.

The Feeding Practices and Structure Questionnaire (FPSQ-28): A parsimonious version validated for longitudinal use from 2 to 5 years.

Prospective studies and intervention evaluations that examine change over time assume that measurement tools measure the same construct at each occasion. In the area of parent-child feeding practices, longitudinal measurement properties of the questionnaires used are rarely verified. To ascertain that measured change in feeding practices reflects true change rather than change in the assessment, structure, or conceptualisation of the constructs over time, this study examined longitudinal measurement invariance of the Feeding Practices and Structure Questionnaire (FPSQ) subscales (9 constructs; 40 items) across 3 time points. Mothers participating in the NOURISH trial reported their feeding practices when children were aged 2, 3.7, and 5 years (N = 404). Confirmatory Factor Analysis (CFA) within a structural equation modelling framework was used. Comparisons of initial cross-sectional models followed by longitudinal modelling of subscales, resulted in the removal of 12 items, including two redundant or poorly performing subscales. The resulting 28-item FPSQ-28 comprised 7 multi-item subscales: Reward for Behaviour, Reward for Eating, Persuasive Feeding, Overt Restriction, Covert Restriction, Structured Meal Setting and Structured Meal Timing. All subscales showed good fit over 3 time points and each displayed at least partial scalar (thresholds equal) longitudinal measurement invariance. We recommend the use of a separate single item indicator to assess the family meal setting. This is the first study to examine longitudinal measurement invariance in a feeding practices questionnaire. Invariance was established, indicating that the subscales of the shortened FPSQ-28 can be used with mothers to validly assess change in 7 feeding constructs in samples of children aged 2-5 years of age.

Tracking Changes in the Endorsement of Injunctive Drinking Norms in Response to the COVID-19 Pandemic Using Longitudinal Alignment Analysis.

The onset of the pandemic saw shifts in messaging around the acceptability of alcohol consumption at different times and contexts. A psychometric analysis of responses to injunctive norms may reveal important differences in specific aspects of norms that were influenced by the pandemic. Study 1 used alignment analysis to evaluate measurement invariance in low- and high-risk injunctive norms across samples of Midwestern college students from 2019 to 2021. Study 2 used an alignment-within-confirmatory factor analysis (CFA) approach to replicate the solution from Study 1 in an independent longitudinal sample (N = 1,148) who responded between 2019 and 2021. For Study 1, the latent mean for high-risk norms was significantly higher in 2021, and the endorsement of four specific norms also differed. In Study 2, increases in latent means for low- and high-risk norms were observed across 2020 and 2021, and differential endorsement emerged for one high-risk norm item. Examining scale-level changes in injunctive drinking norms provides insight into how college students' perceptions changed in response to the COVID-19 pandemic.

Body Uneasiness, Body Figure Perception, and Body Weight: Factor Structure and Longitudinal Measurement Invariance of a Set of Attitudinal and Perceptual Body Image Assessment Tools in Adolescents.

Body image is a multifaceted construct that includes attitudinal and perceptual components, but its attention has mainly been focused on the facet of body dissatisfaction. The present longitudinal study extended the validation of a multifacet attitudinal questionnaire, the Body Uneasiness Test (BUT), against perceptions of body shape and weight. A convenient sample of adolescents took part in a 2-year unbalanced panel study (5 waves). The participants completed the BUT questionnaire and selected their perceived actual, ideal, and reflected body figures along the Contour Drawing Rating Scale; ideal/actual and ideal/normative body mass index discrepancies were also included. After replicating the expected five-factor structure of the BUT items, results from confirmatory factor analysis revealed that the five BUT scales loaded on an attitudinal dimension, whereas the perceived body figures and the discrepancy indices were on a perceptive domain. Such a two-domain structure of body image measures showed gender and seasonal (1-year) measurement invariance, whereas longitudinal 6-month and 18-month invariance partially failed. Overall, the present findings support the validity of the Body Uneasiness Test in adolescence, further demonstrating a preliminary multidimensional structure of body image onto which attitudinal and perceptual body image-related measures were projected.

Longitudinal change of intrinsic capacity and associated factors in older Chinese adults: China Health and Retirement Longitudinal Study.

BACKGROUND: Although intrinsic capacity (IC) has been constructed in older populations, whether IC retains the same structure over time has not been formally examined, nor have the factors associated with the changes in IC over time been thoroughly investigated. This study aimed to establish that the structure of IC remains unchanged over time by testing its longitudinal measurement invariance and to investigate factors that influence the longitudinal change of IC over time. METHODS: Data came from 7,271 participants aged 60 and older from the China Health and Retirement Longitudinal Study in 2011 (Wave 1) and 2015 (Wave 3). Bifactor confirmatory factor analysis (CFA) was used to construct IC with its domains, and the longitudinal measurement invariance of IC between Waves was tested. RESULTS: Bifactor CFA fitted the data well at both Waves and showed good construct validity. Partial scalar invariance was supported with non-invariant intercepts for delayed word recall, math, and close vision. Decreases in IC were associated with increasing age, being female (-0.030, 95% CI: -0.045, -0.016), living in rural areas (-0.019, 95% CI: -0.030, -0.009), BMI < 18.5 (-0.019, 95% CI: -0.035, -0.003), and hypertension (-0.012, 95% CI: -0.022, -0.001). Increases in IC were associated with higher education (primary school: 0.012, 95% CI: 0.001, 0.024; lower secondary school: 0.023, 95% CI: 0.005, 0.041) and drinking ≥4/week (0.019, 95% CI: 0.003, 0.034). Stratifying the sample by gender, the protective effect of education was observed only in women. CONCLUSIONS: The bifactor structure of the IC construct was valid and retained its meaning over time. Longitudinal changes in IC were associated with various sociodemographic factors, lifestyle, and health conditions, confirming the need to monitor IC for timely intervention, particularly in those with risk factors for IC decline.

COVID-stressed schools struggled to teach mathematics.

CONTEXT AND PROBLEM: The COVID-19 pandemic led to temporary closures of schools in Germany that were unpredictable, either short-term or sustained over many weeks depending on local COVID-19 incidence rates which varied in different regions over time. The COVID-19 pandemic created new stressors in schools to deliver the curriculum with reduced lessons and online teaching. COVID-19 also had a marked effect on research in schools. AIM: The INSIDE project is a nationwide German study that investigates the effects of inclusive schooling in secondary education. The data collection started in 2018 and is still ongoing. During the COVID-19 pandemic the drop-out of many schools lead to a sample attrition down to 39.3 % of the original sample. It is investigated whether imputation of missing values in the dependent variables school grades (N = 2999) produces different results than listwise deletion of cases (N = 383). HYPOTHESIS: It is hypothesized that missing data in the longitudinal data design were not missing at random (NMAR). It is further hypothesized based on previous research that in the larger, imputed sample, Math grades will deteriorate more than German grades. RESULTS: Two datasets with observed, respectively, imputed data showed no difference in parents' educational attainment and gender proportion. Larger integrative schools were less likely to drop out than smaller single type schools. Pupils of 'surviving' schools showed equivalent grades for German and Mathematics, while including predicted grades of pupils in 'stressed' drop-out schools showed a decline in Mathematics but not in German subject grades.

Association of longitudinal cardiac troponin trajectory with adverse events in patients with cardiac sarcoidosis.

BACKGROUND: Although high-sensitivity cardiac troponins may be sensitive and easily repeatable markers of disease activity in patients with cardiac sarcoidosis (CS), the association between longitudinal cardiac troponin trajectory and adverse events remains unclear. This study aimed to clarify whether longitudinal cardiac troponin levels were associated with adverse events in patients with CS. METHODS: We examined 63 consecutive CS-initiated prednisolone (PSL) patients with available longitudinal high-sensitivity cardiac troponin T (cTnT) data between December 2013 and March 2023. The area under the cTnT trajectory, which reflected cumulative cTnT release, was calculated to assess the association between longitudinal cTnT levels and adverse events. Patients were divided into two groups according to the median area under the cTnT trajectory per month. The primary outcome was a composite of sustained ventricular tachycardia or fibrillation, worsening heart failure, and sudden cardiac death (SCD). RESULTS: In total, 463 cTnT measurements were collected over a median follow-up period of 30.4 (interquartile range [IQR] 15.6-34.2) months. The primary outcome was observed in 12 (19%) patients. A higher area under the cTnT trajectory was significantly associated with an increased incidence of the primary outcome (P = 0.027), while cTnT levels before and one month after initiation of PSL, and these changes were not related to adverse events (P = 0.179, 0.096, and 0.95, respectively). CONCLUSIONS: Longitudinal cTnT trajectory following PSL initiation was associated with adverse cardiac events in patients with CS, suggesting that longitudinal measurement of cTnT would be useful for the early identification of high-risk patients.